Thanks for your company today and to all those who sent in questions. We hope you felt heard and/or learned something new!

A huge thank you to our panel of experts, Dr Shelley Wilkinson, Dr Natasha Vavrek and Professor Susan Davis.

Remember that if you're experiencing symptoms related to peri/menopause, you don't have to suffer in silence. Chat to a menopause-informed GP about any concerns you might have.

And if you want to learn more about perimenopause, we highly recommend you head over to the Ladies, We Need To Talk series, The Peri Diaries.

Until next time!

It's almost time to love you and leave you, but we do want to address an area we've had many, many questions about: how to find support during peri/menopause. 

Just wondering how or where to find support? The menopause group at the local women's centre — for mental health and social support — is for over-55s only (I'm 49). Meanwhile, I've been waiting over three years for an appointment at the hospital gynaecology clinic to help with my night sweats. These and my insomnia are really debilitating. I don't have enough money for a private gynaecologist. Feeling desperate and unheard.

— Stella, Gosford

So sorry to hear this, Stella. Please know that you are not alone in this. Everyone in this blog (and reading along) has your back!

Dr Shelley says:

GPs with a special interest in women’s health/menopause and perimenopause are covered by Medicare. 

Endocrinologists and gynaecologists are specialists and require a referral. They may be appropriate, but a good GP is a perfect starting point.

Dr Natasha says finding the right support makes all the difference. 

A GP who’s knowledgeable and up to date with menopause care can help you feel heard, understood, and properly treated.

Here’s where to start:

• Check the Australasian Menopause Society’s “find a doctor” tool — it lists health professionals across Australia with a special interest and training in menopause.

• Ask your local GP clinic if any of their doctors have a women’s health interest or menopause training.

• Women’s health clinics and sexual & reproductive health services often have clinicians with more menopause experience.

• If you're in a rural or regional area, consider telehealth options — some menopause specialists offer virtual appointments.  But please make sure they are supported by the Australasian Menopause Society and practice evidence-based management of menopause. 

And if you're not feeling listened to? It’s completely OK to get a second opinion. You deserve care that’s informed, compassionate, and tailored to you. Good luck!

Protein seems to be the health buzzword of the week! Sarah asks: 

Everyone says I need to eat more protein in perimenopause. What is protein for? Should I use protein powder or food? I’m so confused!! 

Dr Shelley has answers for you, Sarah. 

Eating enough protein is important during perimenopause. Protein helps to maintain muscle mass and promote feelings of fullness or satiety.

In Australia, the protein recommendation for women 19-70 years is 0.6g/kg each day. 

We know from population studies in Australia that 99 per cent of Australians under the age of 70 meet their protein requirements from food, so most adults won’t need supplements.

Opting for a food-first approach is preferable. As well as being more familiar and delicious, it comes with other essential nutrients. A balance of animal and plant proteins (a 'flexitarian diet') is a good goal. 

While plant-based proteins are very popular now, it’s important to be selective when you plan to mix up your meal prep, she says. 

We know that ultra-processed foods don’t support healthy gut bacteria, and this may include heavily promoted lab-created fake meats and highly processed and refined plant protein powders.

Minimally processed whole food plant proteins are the way to go. Want some ideas? Include beans, legumes and lentils, nuts, seeds, tofu and tempeh. Nutritious, affordable, and perimenopause-supporting goodness.

Adele has a question about accessing HRT patches — a major and widespread problem.

I am still having difficulty accessing the HRT patches. I have found they work brilliantly with my symptoms: hot flushes, night sweats and sleeplessness. I do have another script for a HRT pill, but it costs a lot more than the patches. I realise this shortage is not unique to Australian women. Any advice on when they may be available again? And why isn't the Kliogest pill on the PBS?

Dr Natasha says: 

You're not alone in facing challenges accessing patches in Australia — it’s been an absolute nightmare for everyone!

These shortages are attributed to manufacturing issues and increased demand, with some brands are not expected to return to normal supply until the end of 2025 unfortunately. It’s absolutely unacceptable that women are unable to access such life-changing medications and definitely gets me worked up!

Regarding the cost, some medications like Kliogest are not listed on the Pharmaceutical Benefits Scheme (PBS), which means they are not subsidised and can be more expensive. The PBS listing process involves assessments of clinical effectiveness and cost-effectiveness, and not all medications meet the criteria for inclusion.​

The good news is that for the first time in over 20 years, there has been the addition of HRT/MHT to the PBS (unfortunately for you, not Kliogest) and they are really great additions that will benefit so many women. For the most current information on medicine availability and PBS listings, you can consult the TGA's medicine shortage database and the PBS website.​ 

Some are wondering if there is a non-hormonal treatment for the symptoms of perimenopause.

I have really bad night sweats and terrible sleep, but I can’t take MHT because of a previous breast cancer diagnosis. Are there any non-hormonal options?

Dr Susan offers this:

Yes, there is a new highly effective treatment called fezolinetant. You can speak to your doctor about this.

Would like more on breast cancer and MHT?  We've got you covered. Check out this story:

What are the different types of MHT out there?  You have options! 

Are different types of estrogen in MHT (eg. gel, patches or tablets) equally good? 

— Alison

Dr Natasha has this to say: 

Yes — different types of estrogen (gel, patch, tablet) can all be effective, but there are some important differences.

Transdermal options (like patches and gel) are often the go-to choice because they:

Bypass the liver (which reduces the risk of blood clots)

Provide steady hormone levels

Are often preferred for people with migraines, high blood pressure or other cardiovascular risk factors.  Your GP may specifically choose a transdermal option if you have certain medical conditions or risks that make oral oestrogen less suitable.

Oral oestrogen (tablets) can still be a great option for many people — convenient and effective, especially if there are no contraindications.

Body-identical oestrogen (like estradiol in patches, gels and some tablets) is chemically identical to what your body naturally produces. It’s generally preferred over synthetic estrogens, which are found in some older HRT/MHT types, as body-identical hormones tend to have fewer side effects and are better tolerated long term.

So what’s best? The best treatment is the one that works for you — safe, effective, and tailored to your health and symptoms. Your GP can help you choose the right fit, and it's totally okay to trial different options!

We've had a few questions about how perimenopause affects people with polycystic ovary syndrome (PCOS).

How could a PCOS diagnosis affect the symptoms and onset of peri/menopause? — Anonymous

I have PCOS and was told I needed to be on the contraceptive Pill (otherwise I have no ovulation/cycle happening). I’m now 45 and still on the pill. How will I know when I’m going through perimenopause/menopause? — Danielle

I am about to turn 40, currently on the contraceptive pill Levlin, suffer from PCOS and endo. How can I tell when I hit perimenopause?

Dr Natasha says:

The average age of menopause in PCOS is not known. A two-year delay in the age of menopause has been estimated in some research.

As you age, PCOS features like irregular cycles often settle down, but that doesn't mean PCOS disappears.

She says that while there’s still a lot we don’t know about how PCOS behaves after menopause, here’s what we do know:

• Some androgen-related symptoms (like hirsutism/excess hair growth) can continue or worsen during midlife.
• Hormone changes can be trickier to track, because the usual PCOS hormone patterns also shift as you age.
• You may be at higher risk for things like metabolic syndrome or cardiovascular disease, so regular check-ins with your doctor are key.

And yes, the diagnostic criteria for PCOS don’t always apply neatly as you get older — which can make this life stage confusing for women and healthcare providers.

You can check out this episode of Ladies, We Need To Talk, all about PCOS.

      Kylie asks: 

What impact is perimenopause likely to have on physical fitness (building strength and muscle, maintaining flexibility, and weight gain/loss)? And how can we deal with these impacts better to keep up quality of life?

Dr Shelley has you covered.

In perimenopause, even if a woman doesn’t experience a change in weight, their muscle and bone mineral density decreases while their fat mass (adipose tissues) increases.

The benefits of being active during perimenopause are undeniable. If moving more could be put in a pill, it would be one of the most powerful medicines around.

She says that research into how to beat weight gain and improve health through menopause suggests: 

• Doing vigorous exercise (more than walking, if you can).

• Doing strength training, ideally at least twice a week.

• Asking your GP to prepare a chronic disease management plan to access a Medicare subsidy for exercise physiology and dietitians.

• Aiming for at least half an hour of moderate-intensity physical activity on most, preferably all days.

• Limiting sedentary behaviour (for example, standing and moving for a few minutes after every hour of sitting).

Yes, fatigue, low mojo and joint pain can hamper your motivation or ability to move more. It's important to start small and gradually build up.

The men have entered the chat!

How should men approach perimenopausal women? Is there information out there for men to consult? — Anon

What’s your best advice to a husband/ partner who is supporting their wife through perimenopause? — Tom

My wife is going through peri-menopause. How do I best create the space to support her when quite often she takes her rage out on me? — Scott

Thank you, fellas, for being supportive of your partners as they go through peri/menopause. It can be a really challenging time for relationships. 

Dr Shelley has an answer for how to approach The Perimenopausal Woman.

Very carefully! 

Just joking — with kindness and understanding. There are some great podcasts out there that cover this topic, including, of course, Ladies, We Need to Talk. The Imperfects also did a great episode with Dr Louise Newson.

Plus, just being here in this blog to learn more about perimenopause is a great start. Here's another article which could be helpful, too:

A great question that requires some clarity!  

What if any is the increased risk of breast cancer or any other cancer when having HRT like estrogen as a gel with progesterone tablets and testosterone? 

— Kel

Dr Natasha weighs in:

When using body-identical MHT — that's oestradiol (Estrogel), micronised progesterone (Prometrium) and testosterone in cream form — the overall cancer risk profile is low for most healthy women under 60 or within 10 years of menopause. Please keep in mind that everyone has different risk profiles though! 

The 2022 Lancet review and other large studies suggest that when body-identical progesterone is used (instead of synthetic progestins) such as micronised progesterone, the risk of breast cancer may be no greater than baseline. 

The E3N French study even showed no increased risk of breast cancer with oestradiol plus micronised progesterone. And transdermal oestrogen (like gel or patches) is absorbed through the skin and bypasses the liver, meaning lower risk of clots or stroke than oral oestrogen. 

So if you're using gel and micronised progesterone, you're on one of the safest evidence-based combinations.

There is no solid evidence that testosterone increases cancer risk when used at physiological (replacement) doses for women. In Australia we have TGA approved testosterone for women who are post menopausal and diagnosed with low libido. 

The absolute increase in breast cancer risk, if any, is very small — less than the risk from drinking one glass of wine daily, being overweight after menopause, or having dense breasts.

Homone therapy is not a one-size-fits-all. The decision should balance your symptoms, age, family history, and personal health goals.